What Is Ectropion? What Causes Ectropion?

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Main Category: Eye Health / Blindness
Also Included In: Seniors / Aging
Article Date: 25 Oct 2009 - 2:00 PDT

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Ectropion is a condition where the lower eyelid droops away from the eye and turns outwards. This leaves the inner eyelid surface exposed and prone to irritation.

According to Medilexicon's medical dictionary, ectropion is: "Eversion of a free edge; usually applied to the eyelid."

The condition is common and can affect anyone, although men are affected more commonly than women. It mostly occurs in older people. It can affect either eyelid or both at the same time.

Ectropion can lead to a watery eye, which may also become red and sore as the tears cannot drain away.

The most frequent cause of ectropion is a weakening of the tendon at the outer corner of the eye, which supports the lower eyelid. The muscle of the lower eyelid can also become slack over time. It can be caused by injury to the skin around the eye. It can also result from a condition called Bell's palsy.

Ectropion cannot be prevented.

There are different degrees of severity. Ectropion ranges from a mild slackness of the lower lid to severe drooping of the whole lid from the eyeball. It may leave the surface of the eye uncovered and as a result make it vulnerable to infection.

If not treated, ectropion may lead to exposure of the cornea. In more serious cases it can cause an ulcer and possibly loss of vision.

Surgery to tighten the lower eyelid is usually effective in treating ectropion.

What are the signs and symptoms of ectropion?

A symptom is something the patient reports and feels, while a sign is something other people, including a doctor may detect. For example, a headache may be a symptom while a rash may be a sign.

When blinking, the eyelids distribute tears evenly across the eyes and keep them lubricated. With a condition such as ectropion, the lower lid is pulling away from the eye; the tears do not drain properly, causing a number of signs and symptoms:

• Watery eyes are the most common symptom. The tear duct (a tiny tunnel in the eyelid that drains away tears from the surface of the eye) can be blocked. The drooping pulls away the opening of the tear duct from the surface of the eye. This prevents the tears from draining properly - they build up inside the drooping eyelid, often causing discomfort, redness and excessive tearing.


• Dry, red and sore eyes. Eyes can become irritated because the drooping lower eyelid prevents the eye from closing properly and old tears from draining away. The eye becomes exposed to the air and is not bathed in fresh tears. It causes a burning sensation and redness in the eyelids and in the whites of the eyes.


• Infection. Since tears cannot properly drain, bacteria are not cleaned away from the surface of the eye. This makes the surface of the eye vulnerable to infection (conjunctivitis), a condition that causes further redness and irritation with a build-up of mucous on the eye.

If eyes are constantly watering or irritated, or the eyelid seems to be sagging or drooping, seek medical advice for an evaluation.

Individuals who have been diagnosed with ectropion, should be alert for symptoms of cornea exposure or ulcers, including rapidly increasing redness, pain, light sensitivity or decreasing vision. If experiencing any of these vision-threatening signs and symptoms, they should seek immediate care in an emergency room.

What are the causes of ectropion?

There are several different causes of ectropion, including:

• Bell's palsy (also known as facial palsy). The muscles of the face, including the muscles that control the eyelids, become paralyzed. This condition is usually temporary and most people make a full recovery within a few months without treatment.


• Congenital ectropion. Rarely, ectropion is congenital and present at birth (usually associated with genetic disorders, such as Down syndrome).


• Eyelid growths. Benign or cancerous growths on your eyelid can cause the lid to turn outward.


• Facial paralysis. When some of the facial nerves and muscles are paralyzed, it can affect the eyelid muscles and cause ectropion.


• Muscle weakness. With age, the muscles under the eyes tend to get weaker as the tendons stretch out. These muscles and tendons hold the eyelid taut against the eye. When they relax, the eyelid can begin to droop and turn outward.


• Previous surgery, radiation or cosmetic procedures. In some cases, previous eyelid surgery (blepharoplasty) can cause ectropion to develop later, particularly if too much skin from the eyelid was removed at the time of surgery. Radiation of the eyelid for a cancerous growth can trigger ectropion to develop. Cosmetic laser skin resurfacing can shrink the eyelid too much, pulling it away from the eye and causing ectropion.


• Rapid weight loss. Occasionally, losing weight very quickly can cause ectropion.


• Scars or skin problems. Scarred skin from facial burns or trauma (such as a dog bite or lacerations..), can affect the way that the eyelid rests against the eye. Skin can become chronically irritated or inflamed (dermatitis). Previous skin cancer in the facial area can also cause ectropion.

How is ectropion diagnosed?

Ectropion can be diagnosed after a routine eye exam and physical examination. Specific tests are usually not necessary as the symptoms and signs of ectropion are distinctive.

If there is a decrease in vision, eye pain, sensitivity to light or rapid increase in redness of the eye, immediately seek medical advice.

If ectropion is caused by a scar, tumor or previous surgery, the surrounding tissue will be examined. It is essential to understand how other conditions cause ectropion in order to choose the correct treatment or surgical technique.

What are the risk factors of ectropion?

A risk factor is something which raises the likelihood of developing a disease or condition. For example, obesity increases the risk of developing diabetes type 2; therefore, obesity is a risk factor for diabetes.

Certain factors increase the risk of developing ectropion:

• Age. The most common cause of ectropion is weakening muscle tissue associated with aging.


• Previous eye surgeries. People who have had eyelid surgery (blepharoplasty) are at higher risk of developing ectropion later.


• Previous cancer, burns or trauma. Spots of skin cancer on the face, facial burns or trauma.

What is the treatment for ectropion?

• Eye drops and ointments can be used to manage symptoms and protect the cornea until a permanent treatment is done. Most cases of ectropion require surgery.


• Daily eye cleansing with cooled, boiled water or with eyewash solution will help to keep the eye clean, until surgery.


• Scar tissue stretching may be considered if the ectropion is caused by a developing scar that is tightening or pulling on the skin. Although not always effective, massaging the scar tissue, injecting it with steroids or doing both may help to modify the scar and relieve the ectropion.


• Surgery - several different surgical techniques exist in treating ectropion. They depend on the cause and the condition of the tissue surrounding the eyelid.
  
  If ectropion is caused by muscle and ligament relaxation due to aging, the surgeon will likely remove a small part of the lower eyelid, which tightens the tendons and muscles of the lid. In general, this procedure is relatively simple.
  
  If there is scar tissue from an injury or previous surgery, the surgeon may need to use a skin graft, taken from the upper eyelid or behind the ear, to help support the lower lid.
  
  If there is paralysis or significant scarring, the outcome of surgery is less predictable, and it is likely that more than one procedure will be necessary before the ectropion is completely resolved.
  
  Following surgery, the use of an eye patch for 24 hours may be necessary, as well as an antibiotic, steroid ointment, cold compresses, acetaminophen (Tylenol, others) for pain. Avoid drugs containing aspirin, because they tend to increase bleeding.
  
  Most people report that their ectropion symptoms are relieved immediately after surgery. Stitches are removed about a week after surgery, swelling and bruising fades after about two weeks. It is important to avoid rubbing the eye or putting pressure on it and to prevent any water getting into it. Avoid swimming for at least three weeks after the operation.

What are the complications of ectropion?

If ectropion is left untreated and is preventing the eye from closing properly, the eye may become progressively more uncomfortable. Because ectropion leaves the cornea irritated and exposed, it is more susceptible to wear (corneal abrasions) and ulcers, which can cause permanent loss of vision.

Exposure of the cornea can damage the eye and must be treated promptly to prevent permanent eye damage.

Some of the warning signs are:

• decreasing or blurry vision
• pain in the eye
• sensitivity to light

Remedies

Some tips can help relieve discomfort until surgery:

• Eye lubricants. To help protect against cornea damage, artificial tears and eye ointments keep the cornea lubricated. Using an eye ointment and a moisture shield that seals in moisture. It is particularly useful overnight.


• Careful wiping of the eyes. Constantly wiping watery eyes can make the under-eye muscles and tendons stretch even further, making ectropion worse. When wiping the eye, use an up-and-in motion, moving from the outer eye up and in toward the nose.


• Skin tape can be used to temporarily tighten the lower lid and relieve some ectropion symptoms. Ask for medical advice to learn the correct use and position of skin tape.

Written by Stephanie Brunner B.A.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today